Heterogeneity of diabetes and disease progression with a tree-like representation: findings from the China Cardiometabolic Disease and Cancer Cohort (4C) study

作者：Xiaojing Jia, Shuangyuan Wang, Hong Lin, Yuanyue Zhu, Yilan Ding, Mian Li, Yu Xu, Min Xu, Feiyue Huang, Feixia Shen, Xuejiang Gu, Yiming Mu, Lulu Chen, Tianshu Zeng, Lixin Shi, Qing Su, Xuefeng Yu, Li Yan, Guijun Qin, Qin Wan, Gang Chen, Xulei Tang, Zhengnan Gao, Ruying Hu, Zuojie Luo, Yingfen Qin, Li Chen, Xinguo Hou, Yanan Huo, Qiang Li, Guixia Wang, Yinfei Zhang, Chao Liu, Youmin Wang, Shengli Wu, Tao Yang, Huacong Deng, Yifang Zhang, Huapeng Wei, Jie Zheng, Tiange Wang, Zhiyun Zhao, Zhao JiaJun, Guang Ning, Wei‐Qing Wang, Yufang Bi, Jieli Lu, for the 4C Study Group · 发表于：Diabetologia · 年份：2025 · DOI：10.1007/s00125-025-06528-x · 被引用次数：9 · 研究领域：Diabetes, Cardiovascular Risks, and Lipoproteins、Genetic Associations and Epidemiology、Metabolism, Diabetes, and Cancer

AIMS/HYPOTHESIS: Diabetes heterogeneity has been modelled as a continuum in European populations, but its phenotypes and long-term comorbidity risks remain unclear in Chinese individuals. This study aimed to identify distinct phenotypes and evaluate their links to future cardiometabolic risks in a large Chinese cohort. METHODS: The discriminative dimensionality reduction with trees (DDRTree) algorithm was used to develop a tree structure based on nine clinical variables. Cox proportional hazard models or logistic regression models were used to analyse probabilities of diabetes-related outcomes. RESULTS: This study included 19,612 individuals with newly diagnosed diabetes (36.8% male, mean age 59.01 years [SD 8.63]) from the China Cardiometabolic Disease and Cancer Cohort (4C) study. All nine clinical variables used for establishing DDRTree models were gradient distributed across the tree. By overlaying risks of diabetes-related outcomes, we show how these risks differ by participant phenotype. Participants characterised by hyperglycaemia, obesity and dyslipidaemia showed elevated risks of insulin initiation, hypoglycaemia and chronic kidney diseases, while those with hypertension and high creatinine, total cholesterol and alanine aminotransferase levels were associated with a higher risk of CVD. Notably, social determinants and lifestyle factors further contributed to the observed heterogeneity. CONCLUSIONS/INTERPRETATION: These findings characterise the heterogeneity of diab...